Comprehensive Multicomponent Cardiac Rehabilitation
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European Journal of Preventive Cardiology CONSENSUS DOCUMENT doi:10.1093/eurjpc/zwaa121 Cardiac rehabilitation Comprehensive multicomponent cardiac rehabilitation in cardiac implantable electronic Downloaded from https://academic.oup.com/eurjpc/advance-article/doi/10.1093/eurjpc/zwaa121/6119672 by guest on 21 February 2021 devices recipients: a consensus document from the European Association of Preventive Cardiology (EAPC; Secondary prevention and rehabilitation section) and European Heart Rhythm Association (EHRA) Roberto F.E. Pedretti 1*, Marie-Christine Iliou2, Carsten W. Israel3, Ana Abreu4, Hielko Miljoen 5, Ugo Corra` 6, Christoph Stellbrink7, Andreas B. Gevaert5, Dominic A. Theuns8, Massimo F. Piepoli9, Rona Reibis10,11, Jean Paul Schmid12, Matthias Wilhelm13, Hein Heidbuchel5†, and Heinz Vo¨ller14,15† Document reviewers: Marco Ambrosetti16, Thomas Deneke17, Veronique Cornelissen18, Frank R. Heinzel19,20, Constantinos H. Davos21, Gulmira Kudaiberdieva22, Ines Frederix23,24,25,26, Jesper Hastrup Svendsen27,28, and Dominique Hansen29,30 1Cardiovascular Department, IRCCS MultiMedica, Care and Research Institute, Via Milanese 300, Sesto San Giovanni, Milano 20099, Italy; 2Department of Cardiac Rehabilitation and Secondary Prevention, Hoˆpital Corentin Celton, Assistance Pulique Hopitaux de Paris centre-Universite de Paris, France; 3Department of Cardiology, Bethel Clinic, J.W. Goethe University, Frankfurt, Germany; 4Servico de Cardiologia, Hospital Universita´rio de Santa Maria/Centro Hospitalar Universita´rio Lisboa Norte (CHULN), Centro Academico de Medicina de Lisboa (CAML), Centro Cardiovascular da Universidade de Lisboa (CCUL), Faculdade de Medicina, Universidade de Lisboa, Portugal; 5Department of Cardiology, University of Antwerp and University Hospital Antwerp, and Antwerp University, Antwerp, Belgium; 6Department of Cardiac Rehabilitation, ICS Maugeri Care and Research Institute, Veruno, Novara, Italy; 7Department of Cardiology and Intensive Care Medicine, Klinikum Bielefeld GmbH, Bielefeld, Germany; 8Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands; 9Heart Failure Unit, G. da Saliceto Hospital, AUSL Piacenza and University of Parma, Parma, Italy; 10Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany; 11Cardiac Outpatient Clinic Am Park Sanssouci, Potsdam, Germany; 12Department of Cardiology, Clinic Barmelweid, Erlinsbach, Switzerland; 13Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; 14Department of Rehabilitation Medicine, Faculty of Health Sciences Brandenburg, University of Potsdam, Potsdam, Germany; 15Klinik am See, Rehabilitation Centre for Internal Medicine, Ru¨dersdorf, Germany; 16Cardiovascular Rehabilitation Unit, ASST Crema, Santa Marta Hospital, Rivolta d’Adda, Italy; 17Heart Center Rho¨n-Klinikum Campus Bad Neustadt, Bad Neustadt, Germany; 18Cardiovascular Exercise Physiology Unit, Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium; 19Department of Cardiology, Charite´— Universitaetsmedizin Berlin, Campus Virchow-Klinikum, Berlin, Germany; 20Berlin Institute of Health, Berlin, Germany; 21Cardiovascular Research Laboratory, Biomedical Research Foundation, Academy of Athens, Athens, Greece; 22SRI of Heart Surgery and Organ Transplantation, Center Scientific Research and Development of Education, Bishkek Kyrgyzstan, Adana, Turkey; 23Hasselt University, Faculty of Medicine & Life Sciences, Hasselt, Belgium; 24Antwerp University, Faculty of Medicine & Health Sciences, Antwerp, Belgium; 25Department of Cardiology, Jessa Hospital, Hasselt, Belgium; 26Intensive Care Unit, Antwerp University Hospital, Edegem, Belgium; 27Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark; 28Department of Cardiology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark; 29Heart Centre Hasselt, Jessa Hospital, Hasselt, Belgium; and 30Faculty of Medicine and Life Sciences, UHasselt, BIOMED-REVAL-Rehabilitation Research Centre, Hasselt University, Hasselt, Belgium Received 14 September 2020; revised 25 October 2020; editorial decision 28 October 2020; accepted 2 November 2020 Cardiac rehabilitation (CR) is a multidisciplinary intervention including patient assessment and medical actions to promote stabilization, management of cardiovascular risk factors, vocational support, psychosocial management, physical activity counselling, and prescription of * Corresponding author. Tel: þ39 02 24209590, Email: [email protected] † These authors shared last authorship. Published on behalf of the European Society of Cardiology. All rights reserved. VC The Author(s) 2021. For permissions, please email: [email protected]. 2 R.F.E. Pedretti et al. exercise training. Millions of people with cardiac implantable electronic devices live in Europe and their numbers are progressively increas- ing, therefore, large subsets of patients admitted in CR facilities have a cardiac implantable electronic device. Patients who are cardiac implantable electronic devices recipients are considered eligible for a CR programme. This is not only related to the underlying heart disease but also to specific issues, such as psychological adaptation to living with an implanted device and, in implantable cardioverter-defibrillator patients, the risk of arrhythmia, syncope, and sudden cardiac death. Therefore, these patients should receive spe- cial attention, as their needs may differ from other patients participating in CR. As evidence from studies of CR in patients with cardiac implantable electronic devices is sparse, detailed clinical practice guidelines are lacking. Here, we aim to provide practical recommenda- tions for CR in cardiac implantable electronic devices recipients in order to increase CR implementation, efficacy, and safety in this subset Downloaded from https://academic.oup.com/eurjpc/advance-article/doi/10.1093/eurjpc/zwaa121/6119672 by guest on 21 February 2021 of patients. ................................................................................................................................................................................................... Keywords Cardiac rehabilitation • Cardiac implantable electronic devices • Pacemaker • Implantable cardioverter- defibrillator • Cardiac resynchronization therapy • Prevention • Exercise training • Heart failure • Physical activity . of life (QoL), and increasing survival. Exercise training is a key compo- Why should the heterogeneous . nent of a CR programme: together with CIED functions like rate sta- group of cardiac implantable . bilization, chronotropic support, and resynchronization, it may . 3 electronic device recipients . provide a significant synergistic effect on heart function. In ICD recipients, fear of shocks often leads to fear of exercise and perform cardiac rehabilitation? . self-limitation of everyday activities. In addition, referral from hospi- . tals to CR centres is often negatively impacted by the fear of inappro- Cardiac rehabilitation (CR) is a multidisciplinary intervention, which is . recognized as integral to the comprehensive care of cardiac patients.1 . priate shock delivery during exercise. These aspects can therefore . deprive ICD recipients of the well-established beneficial effects of CR Core components of CR include patient assessment and medical . actions to promote stabilization, management of cardiovascular risk . in terms of secondary prevention, physiological, and psychosocial . factors, vocational support, psychosocial management, physical activ- . functioning. As evidence from studies of CR in patients with CIED is sparse, ity counselling, and prescription of exercise training (ET). Currently, millions of people with cardiac implantable electronic . detailed clinical practice guidelines are lacking. Here, we aim to pro- . vide practical recommendations for CR in CIED recipients in order device (CIED) live in Europe and hundreds of thousands join them . every year: according to a 2017 report of the European Heart . to increase CR implementation, efficacy, and safety in this subset of . patients. Rhythm Association (EHRA), a total of 547 586 pacemakers (PMs), . 105 730 implantable cardioverter-defibrillators (ICDs), and 87 654 . cardiac resynchronization therapy (CRT) devices were implanted in . 2 . Summary box 1 the ESC area in 2016. • Hence, large subsets of patients participating in CR programmes . Patients who are CIED recipients are considered eligible for have a PM, CRT, or ICD. Cardiac rehabilitation for patients with . a CR programme. This is not only related to the underlying . heart disease but also to specific issues, such as psychological CIED is a unique opportunity not only to optimize medical treatment, . to increase exercise capacity, and to improve their clinical condition . adaptation to living with an implanted device and, in ICD . patients, the risk of arrhythmia, syncope, and sudden cardiac but also to supervise the correct functioning of the device. death. Therefore, these patients should receive special atten- Patients who are CIED recipients are considered eligible for a CR . tion, as their needs may differ from other patients participat- 1 . programme. This is not only related to the underlying heart disease . ing in CR. but also to specific issues, such as psychological adaptation to living . • The present paper is aimed to provide practical recommen- with an